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目的:比较成人急性淋巴细胞白血病(ALL)患者不同诱导化疗方案治疗的疗效。方法:回顾性分析医科院血液病医院从1998年6月—2008年1月新诊断、治疗的ALL患者124例。采用SPSS13.0统计学软件分析有关数据。结果:①根据诱导治疗方案分为VDCLP、VDCP2组,2组的1疗程CR率为87.9%和84.5%,总CR为93.9%和89.7%。VDCLP组中位无病生存(DFS)21(0～116)个月,中位总生存(OS)23(2～117)个月;VDCP组中位DFS10(0～109)个月,中位OS14(1～110)个月。2组的3年DFS分别为55.2%和19.2%。2组的3年OS率56.2%和21.1%,(P<0.05)。②≤30岁的青少年和年轻成人ALL采用VDCLP和VDCP方案1疗程CR率分别为92.7%和86.8%,总CR率分别为97.6%和94.7%。VDCLP组中位DFS23(0～116)个月,中位OS24(2～117)个月;VDCP组中位DFS10(0～109)个月、中位OS14(1～110)个月。2组的3年DFS分别为60.4%和18.2%。2组的3年OS率62.9%和20.9%。③采用VDCLP方案诱导治疗的染色体核型标危组成人ALL,VDCLP组中位DFS22(0～116)个月、中位OS24(3～117)个月;VDCP方案诱导治疗中位DFS13(0～109)个月、中位OS19(1～110)个月。2组的3年DFS分别为59.0%和DFS23.3%。2组的3年OS率60.7%和29.8%。而染色体核型高危成人ALL,VDCLP组中位DFS6(0～32)个月,中位OS17(2～38)个月;VDCP组中位DFS8(0～20)个月,中位OS10(5～23)个月。2组的3年DFS分别为0.0%和DFS0.0%。2组的3年OS率0.0%和0.0%。结论:诱导治疗中加L-Asp对CR率无明显影响,但诱导治疗采用VDCLP较VDCP可以提高成人ALL的DFS和OS。
Objective: To compare the efficacy of different induction chemotherapy regimens in adult patients with acute lymphoblastic leukemia (ALL). Methods: A retrospective analysis of 124 cases of ALL patients newly diagnosed and treated from June 1998 to January 2008 in Hematology Hospital of Medical College. Using SPSS13.0 statistical software analysis of the data. Results: ① According to induction therapy, VDCLP and VDCP2 groups had a CR rate of 87.9% and 84.5% in one course of treatment, with a total CR of 93.9% and 89.7%. In the VDCLP group, median disease-free survival (DFS) was 21 (range, 0-116) months with a median OS of 23 (range, 2 to 117) months. Median VDFS patients with median DFS10 (range, 0-109) OS14 (1 ~ 110) months. The 2-year 3-year DFS was 55.2% and 19.2%, respectively. The 3-year OS rates were 56.2% and 21.1% in both groups (P <0.05). ② CR rate of 92% and 86.8% of the children under the age of 30 and adolescents with VDCLP and VDCP regimen were less than 30 years. The total CR rates were 97.6% and 94.7% respectively. In the VDCLP group, median DFS23 was (0-116) months and median OS24 (range, 2 to 117) months; median DFS10 (ranged from 0 to 109) and median OS14 (range, 1 to 110) months in VDCP group. The 3-year DFS for the 2 groups was 60.4% and 18.2%, respectively. The 3-year OS rates in the two groups were 62.9% and 20.9%. (3) DFS22 (0-116) months and median OS24 (3-117) months were detected in patients with VD, which was induced by VDCLP. Median DFS13 (0 ~ 109) months, the median OS19 (1 ~ 110) months. The 3-year DFS for the 2 groups was 59.0% and DFS 23.3%, respectively. The 3-year OS rates in the 2 groups were 60.7% and 29.8%. The median DFS6 (0 ~ 32) months and median OS17 (2 ~ 38) months in the adults with chromosomal karyotype at high risk of VDCLP were significantly lower than those in the VDCP group ~ 23) months. The 3-year DFS for the 2 groups was 0.0% and DFS 0.0%, respectively. The 3-year OS rates in both groups were 0.0% and 0.0%. Conclusion: Induction therapy with L-Asp has no significant effect on CR rate. However, VDCLP can increase DFS and OS in adults with induction therapy.